March 4, 2014 by Stephen Birman
To qualify for the weekly non-earner benefit under the Statutory Accident Benefits Schedule (SABS), an insured person must meet the rigorous “complete inability to carry on a normal life” test (the “complete inability test”). Accident victims who do not work at the time of the accident (and do not qualify for an income replacement benefit) will need to satisfy this test in order to qualify for a weekly benefit. Despite the stringent test for qualification, accident victims who...
July 18, 2013 by Stacey Stevens
On January 4, 2013, I discussed two key decisions requiring an Accident Benefit Insurer to pay its insured an attendant care benefit based on a Form 1 Assessment of Attendant Care and not the costs associated with obtaining this service or the economic loss suffered by the care provider in doing so.
On July 26, 2013, the Ontario Court of Appeal, in Henry v. Gore Mutual Insurance Company 2013 ONCA 480 upheld the lower court’s ruling that the economic loss requirement contained...
July 11, 2013 by David MacDonald
Ian W. K. Furlong
Courts and Arbitrators have helped us to understand how the definition of catastrophic impairment may apply to individuals who suffer very severe injuries in motor vehicle accidents. These same decisions have helped us to understand that clinical findings by treating and assessing health care professionals are integral to the process of evaluating whether a person has sustained a catastrophic impairment.
The goal of this...
June 4, 2013 by Deanna Gilbert
In what seems to be an increasing phenomenon, injured Plaintiffs/Insureds are being asked to sign Consent Forms when they attend a tort defence medical examination or an insurer examination (“IE”) pursuant to the SABS. A common scenario arises when the Plaintiff/insured is suddenly presented with a Consent Form; refuses to sign it without first consulting with her lawyer; the examiner refuses to proceed with the assessment; and the whole process is stalled.
Is There a Legal...
May 29, 2013 by David Payne
Adam J. Tanel
Associate, Thomson, Rogers
The accident benefits maze is difficult to navigate at the best of times. This is especially true for victims of a traumatic brain injury (TBI). The Ontario Government recognized this special vulnerability with a 2010 regulation that declared that any individual with a Glasgow Coma Scale (GCS) reading of 9 or less (as the result of a collision) is automatically deemed to be catastrophically impaired.
The purpose of this regulation was to create a “bright...
May 15, 2013 by Stacey Stevens
Esther J. Roche
Changes to Section 3 of the Statutory Accident Benefits Schedule (“the SABS”) were introduced by the Government of Ontario on September 1, 2010. The changes require an insured to prove expenses have been incurred in order to receive attendant care, housekeeping, and med/rehab benefits. Section 3(7)(e) of the SABS states that in order for an expense to be “incurred”, and thus payable by the insurer, it must...
April 4, 2013 by Stephen Birman
On March 26, 2013, a decision was rendered by the Financial Services Commission of Ontario in the case of Lenworth Scarlett and Belair Insurance Company Inc.
The applicant, Lenworth Scarlett, suffered soft tissue injuries, psychological injury and a TMJ injury arising from a motor vehicle accident which occurred on September 18, 2010.
The decision of Arbitrator John Wilson is the first decision regarding the Minor Injury Guideline ("MIG") pursuant to the MIG which came into effect on September 1...
March 25, 2013 by Thomson Rogers
Since the Sept. 1, 2010 re-introduction of the concept of "incurred" expenses and the qualifying term "economic loss" in the Statutory Accident Benefits Schedule, automobile insurers and accident victims have debated how the terms incurred and economic loss should be applied when paying for allowable goods or services, Toronto personal injury lawyer Stacey L. Stevens writes in Lawyers Weekly.
"The debate is even more pronounced when the person providing the goods or services is a...